AFFIDAVIT OF VOTER REQUIRING ASSISTANCE
Under the penalty prescribed by law I hereby make affidavit that
I, _____________________________________ , | of _____________________________________ |
Print Name of Voter | Street Address of Voter |
_____________________________________ , hereby choose _____________________________________ | |
City/Town of Voter | Print Name of Assistant |
to provide assistance to me because I am either blind, disabled or unable to read or write in the English language and do hereby certify that the person chosen to assist me is not my employer, or agent of my employer, or officer or agent of my union.
Signature of Voter
Under the penalty prescribed by law I hereby make affidavit that
I, Print Name of Person Assisting Voter, of
_________
Street and City/Town Address of Person Assisting Voter
having been chosen by Print Name of Voter
to provide assistance to voter by reason of either blindness, disability or inability to read or write in the English language on the part of the voter, do hereby certify that I am not the voter's employer, or agent of that employer, or officer or agent of the voter's union.
Signature of Person Assisting Voter
Subscribed and sworn to on this _________ day of ___________________ A.D. 20 _________.
Signature of Warden
Voter's Ballot Application No. _________
R.I. Gen. Laws § 17-19-26.1